COMPLETE DIGESTIVE STOOL ANALYSIS - Level 3+

Transcription

1 COMPLETE DIGESTIVE STOOL ANALYSIS - Level 3+ MACROSCOPIC DESCRIPTION Stool Colour Brown Result Brown Colour - Brown is the colour of normal stool. Other colours may indicate abnormal GIT conditions. Stool Form Formed Formed Form -A formed stool is considered normal. Variations to this may indicate abnormal GIT conditions. Mucous Mucous - Mucous production may indcate the presence of an infection, inflammation or malignancy. Blood (Macro) Blood (Macro)- The presence of blood in the stool may indicate possible GIT ulcer, and must always be investigated immediately. Macroscopy Comment BROWN coloured stool is considered normal in appearance. MICROSCOPIC DESCRIPTION Result RBCs (Micro) RBC(Micro) - The presence of RBCs in the stool may indicate the presence of an infection, inflammation or haemorrhage. WBCs (Micro) Food Remnants Fat Globules Starch 0 < 10 + WBC(Micro) - The presence of WBCs in the stool may indicate the presence of an infection, inflammation or haemorrhage. Food Remnants - The presence of food remnants may indicate maldigestion. Fat Globules -The presence of fat globules may indicate fat maldigestion. Starch - The presence of starch grains may indicate carbohydrate maldigestion. Microscopy Comment FOOD REMNANTS PRESENT: Consider hypochlorhydria, pancreatic insufficiency, inadequate chewing. Treatment: Consider hydrochloride, digestive enzymes or other digestive aids Improve chewing Assess other CDSA markers such as ph, pancreatic elastase 1, H. pylori & other food fibres. Page 1 of 8 CDSA 3+ Lab ID: Patient Name :

2 DIGESTIVE MARKERS Chymotrypsin 6.9 U/g Chymotrypsin - Chymotrypsin is involved in protein digestion. Low levels of chymotrypsin may indicate protein maldigestion due to pancreatic insufficiency. Short Chain Fatty Acids, Putrefactive 4.9 umol/g Short Chain Fatty Acids, Putrefactive - Putrefactive SCFAs are produced when anaerobic bacteria ferment undigested protein, indicating protein maldigestion. Result Meat Fibres Vegetable Fibres + + Meat Fibres - The presence of meat fibres may indicate maldigestion from gastric hypoacidity or diminished pancreatic output. Vegetable Fibres - The presence of vegetable fibres may indicate maldigestion from gastric hypoacidity or diminished pancreatic output. Pancreatic Elastase > 200 ug/g Pancreatic Elastase is used to assess pancreatic exocrine function. Pancreatic insufficiency is associated with diabetes mellitus, cholelithiasis, pancreatic tumour, cystic fibrosis and osteoporosis.this test is not affected by substitution therapy with enzymes of animal origin. PE-1 levels decline with age. Digestive Comment PANCREATIC ELASTASE: Normal exocrine pancreatic function. Pancreatic Elastase reflects trypsin, chymotrypsin, amylase and lipase activity. This test is not affected by supplements of pancreatic enzymes. Healthy individuals produce on average 500 ug/g of PE-1. Thus, levels below 500 ug/g and above 200 ug/g suggest a deviation from optimal pancreatic function. The clinician should therefore consider digestive enzyme supplementation if one or more of the following conditions is present: Loose watery stools, Undigested food in the stools, Post-prandial abdominal pain, Nausea or colicky abdominal pain, Gastroesophageal reflux symptoms, Bloating or food intolerance. Page 2 of 8 CDSA 3+ Lab ID: Patient Name :

3 ABSORPTION MARKERS Triglycerides, Stool 290 Long Chain Fatty Acids 3.5 < 400 mg/dl mmol/l Cholesterol, Stool 104 Phospholipids < 70.0 mg/dl 4.6 mg/g Absorption Comment Triglycerides, Stool - Elevated levels of Triglycerides in the stool may indicate lipid maldigestion. Long Chain Fatty Acids - Elevated levels of LCFAs in the stool may indicate inadequate lipid absorption. Cholesterol, Stool - Elevated levels of Cholesterol in the stool may indicate inadequate absorption. Phospholipids - Elevated levels of Phospholipids in the stool may indicate inadequate absorption. Phospholipid levels ELEVATED: Suspect malabsorption, reduced bile salt resorption or increased mucosal cell turnover. Page 3 of 8 CDSA 3+ Lab ID: Patient Name :

4 METABOLIC MARKERS Short Chain Fatty Acids, Beneficial 212 Short Chain Fatty Acids, Beneficial (Total) - Elevated SCFAs may indicate bacterial overgrowth. Inadequate SCFAs may > 13.6 umol/g indicate inadequate normal flora. Butyrate 32.5 b-glucuronidase U/g ph Acetate 50.1 Propionate % % % Butyrate - Decreased Butyrate levels may indicate inadequate colonic function. b-glucuronidase - Increased levels of b-glucuronidase may reverse the effects of Pase II detoxification processes. ph - Imbalances in gut ph, will influence SCFA production and effect. Acetate - Decreased Acetate levels may indicate inadequate colonic function. Propionate - Decreased Propionate levels may indicate inadequate colonic function. Metabolic Comment beta Glucuronidase ELEVATED: Suspect increased activation and enterohepatic recirculation of toxins, hormones, and various drugs within the body. Increased burden on glucuronidation pathway is associated with increased risk of colorectal, prostate and breast cancers Butyrate levels are ELEVATED: High levels are associated with carbohydrate intolerance and diarrhoea. LOW ph PRESENT: High Acidity stool. Consider bacterial overgrowth, lipid or carbohydrate malabsorption, rapid transit time, pancreatic insufficiency. Treatment: Supplement digestive enzymes or other digestive aids Assess other CDSA markers such as fat globules, food remnants, transglutaminase IgA & microbiology markers. Investigate causes of malabsorption or diarrhoea. Page 4 of 8 CDSA 3+ Lab ID: Patient Name :

5 INFLAMMATION MARKERS Transglutaminase IgA ug/g Comment- Tissue transglutaminase is the most specific test for Coeliac Disease. Gluten-sensitive patients react to Gliadin (found in wheat, barley and rye gluten) and to an antigenic component of the gut endomysium, now known to be tissue Transglutaminase (ttg), which uses gliadin as a substrate in creating antigenic neo-epitopes which generate the immune response in genetically susceptible individuals. After several weeks on a Gluten-free diet, ttg antibody levels may return towards normal levels. Eosinophil Protein X Comment < 7.0 ug/g Calprotectin 24.0 Normal <50 ug/g Mildly Elevated ug/g HIghly Elevated ug/g Extremely Elevated >250 ug/g Comments: Calprotectin is a protein that is abundant in neutrophilic granulocytes and is a sensitive and direct indicator of bowel inflammation. In patients with Inflammatory Bowel Disease (Crohn s Disease, Ulcerative Colitis), including those in relapse, there is a close positive correlation between faecal Calprotectin levels and the degree of inflammation; patients with Irritable Bowel Syndrome do not have elevated levels of Calprotectin. Calprotectin is very stable in stool samples. Inflammation Comment CALPROTECTIN Normal: Low/Absent inflammation of the GIT. Patients without GIT inflammation and untreated IBS sufferers have levels below 50 ug/g. FAECAL TRANSGLUTAMINASE IgA: Negative Tissue Transglutaminase is the most specific test for Coeliac Disease. Levels less than 100 are considered NEGATIVE. Treatment: No treatment required. However, If there is clinical suspicion of Coeliac disease consider testing serum Coeliac markers. Page 5 of 8 CDSA 3+ Lab ID: Patient Name :

6 TUMOUR/ULCER MARKERS M2 Pyruvate Kinase 3.6 <= 4U/ml >4 U/ml Comment - The majority of human tumours strongly over-express the tumour M2 isoform of the glycolytic enzyme Pyruvate Kinase (M2-PK), which is released from tumour cells and is quantitatively detectable in body fluids. M2-PK is the key regulator of tumour metabolism and its measurement in faeces identifies gastrointestinal tumours, even in the absence of gastrointestinal bleeding. H. PYLORI, Antigen Negative Comment - Helicobacter Pylori antigen indicates the patient's current status and is not affected by the presence of other organisms, antacids, barium sulphate, blood or fat. This test may be used on its own to monitor the success of eradication therapy one month after completion of the therapy. Tumour/Ulcer Comment H. PYLORI ANTIGEN: This test, if POSITIVE, indicates the presence of a current infection and is not affected by the presence of other organisms, antacids, barium sulphate, blood or fat. If the patient has diagnosed gastritis or a peptic ulcer consider: Standard triple therapy: eg. PPI, clarithromycin and amoxicillin/or metronidazole, 7-14 days Lactobacillus Probiotics If the patient is asymptomatic consider natural products including: Black currant seed oil and fish oil Lactobacillus Probiotics Vitamin C Mastic gum. M2-PYRUVATE KINASE: Negative M2-PK values greater than 4 U/mL may indicate gastrointestinal adenoma, colorectal cancer or other gastrointestinal carcinomas. Tumor M2-PK has a higher sensitivity than markers CEA and CA72-4, and is am2-pk values greater than 4 U/mL may indicate gastrointestinal adenoma, colorectal cancer or other gastrointestinal carcinomas. M2-PK has a lower sensitivity and specificity in diagnosing pancreatic cancer compared to Ca However, in patients with adenocarcinoma there is a simultaneous increase of M2-PK and Ca In addition, M2-PK is more commonly elevated in metastatic disease and may be an additional criterium to decide on radical surgery of pancreatic cancer. Tumor M2-PK has a higher sensitivity than markers CEA and CA72-4, and is a valuable tumor marker for the detection of gastrointestinal cancer. Page 6 of 8 CDSA 3+ Lab ID: Patient Name :

7 BENEFICIAL BACTERIA Result Bifidobacteria Lactobacilli Eschericia coli Enterococci COMMENTS: Significant numbers of Lactobacilli, Bifidobacteria and E coli are normally present in the healthy gut: Lactobacilli and Bifidobacteria, in particular, are essential for gut health because they contribute to 1) the inhibition of gut pathogens and carcinogens. 2) the control of intetinal ph, 3) the reduction of cholesterol, 4) the synthesis of vitamins and disaccharidase enzymes. OTHER BACTERIA Result Klebsiella ++++ Pseudomonas Campylobacter Citrobacter Yersinia COMMENTS: Reduced numbers of these organisms - whether caused by antibiotic use, chronic maldigestion or bacterial overgrowth leave the intestine susceptible to colonisation by pathogens and production of carcinogens. A reduction in the desirable levels of beneficial bacteria indicates the need for supplementation. YEASTS Result Candida albicans COMMENTS: Other Yeasts PARASITES Result Cryptosporidium COMMENTS: Giardia lamblia Entamoeba Histolytica Blastocystis Hominis Other Parasites Parasitology Comment OTHER PARASITE ANTIGENS DETECTED As routine parasitology investigations have yielded negative results, if symptoms persist we suggest faecal Multiplex DNA PCR testing. This is a more sensitive technique that can identify the presence of specific DNA of 10 commonly observed parasites/bacteria. Please contact Nutripath Customer Service with your enquiries. Page 7 of 8 CDSA 3+ Lab ID: Patient Name :

8 MICROORGANISM SUMMARY Adequate levels of Bifidobacteria detected. Adequate levels of Lactobacilli detected. Klebsiella sp. PRESENT: Klebsiella is isolated from foods and environmental sources. Klebsiella appears to thrive in individuals on a high starch diet. Avoiding carbohydrates such as rice, potatoes, flour products and sugary foods reduces the amount of Klebsiella in the gut. Klebsiella forms part of the normal GI flora in small numbers, but can be an opportunistic pathogen. Currently, standard texts provide no specific antimicrobial guidelines for GI overgrowth of Klebsiella. Klebsiella organisms are resistant to multiple antibiotics. Treatment depends on the organ system involved. Other Bacteria Identified: ANTIBIOTIC SENSITIVITIES Penicillin. Ampicillin Erythromycin Tetracycline Sulphonamides Trimethoprim Ciprofloxacin Gentamycin. Ticarcillin Tobramycin Augmentin Cephalexin Klebsiella pneumoniae Susceptible Page 8 of 8 CDSA 3+ Lab ID: Patient Name :

9 OTHER BACTERIA DETECTED: Organism Growth Classification alpha-haemolytic Streptococcus 4+ Non-Pathogen gamma-haemolytic Streptococcus 4+ Non-Pathogen Bacillus species 1+ Non-Pathogen Klebsiella pneumoniae 4+ POSSIBLE Pathogen In general Bacillus species demonstrate variable susceptibility to the penicillins and cephalosporin antibiotics. Clindamycin and Vancomycin have shown effective activity when used to treat serious infections. NATURAL AGENTS SENSITIVITIES: Organism Agent Inhibition Level Klebsiella pneumoniae Berberine 60% Oregano 40% Plant Tannins 60% Uva-Ursi 60% INHIBITION CATEGORY: R Resistant: This category indicates that the organism is not inhibited by obtainable levels of the pharmaceutical agent I Intermediate: This category indicates where the minimum inhibition concentrations (MIC) approach obtainable pharmaceutical agent levels and for which response rtates may be lower than for susceptible isolates. S-DD Susceptible, This category indicates that clinical efficacy is achieved when higher than normal dosage of a drug is used to Dose Dependent: achieve maximal concentrations. S Susceptible This category indicates that the organisms are inhibited by the usual achievable concentration of the agent. NI No Intrepretive This category indicates that there are no established guidelines for MIC interpretation for these organisms. Guidelines